Permit . j CITY OF TIGARD SEWER CONNECTION PERMIT
l DEVELOPMENT SERVICES PERMIT #: SWR2001 -00077
All '
--- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/6/01
SITE ADDRESS; 12930 SW 113TH PL PARCEL: 2S103AC -07600
SUBDIVISION: FONNER WOODS ZONING: R -4.5
BLOCK: LOT: 012 JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS: 1
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection for new SF detached dwelling.
Owner:
FEES
PINE VALLEY BUILDERS INC Type By Date Amount Receipt
1052 TROON ROAD
LAKE OSWEGO, OR 97034 PRMT CTR 4/6/01 $2,300.00 27200100000
INSP CTR 4/6/01 $35.00 27200100000
Phone: 503 - 358 -7667 Total $2,335.00
Contractor:
Phone:
Reg #:
Required Inspections
This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires
180 days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not
guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer
shall prospect 3 feet in all directions from the distance given. If not so located, the installer shall purchase a "Tap and
Side Sewer' Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow rules adopted
by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 101 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
1
Issued by: P ermittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next ' u -4es say
CITY OF TIGARD BUILDING INSPECTION DIVISION MST r .
24 -Hour Inspection Line: 639 -4175 Business Line: 6 -4171
/ BUP
1
Date Requested / ( AM PM BLD
Location /, - f 2' Sw / #3 /Lf• Suite MEC
Contact Person Ph - 3 730 "' 7b PLM
Contractor Ph SWR 006 77
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: SGN
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
MBMN
Post & Beam
Under Slab
Top Out l
Water Service
ani - -
ain Drains 1 /
W O PART FAIL
HANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading -
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach/Sidewalk Date / / / / ( Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.